Towards laboratory knowledge, not data, in 70% of clinical decision-making. What "knowledge management" can add to clinical practice?

Towards a Comprehensive Knowledge Management Improvement Model for Medical Laboratories

Medical laboratories are complex facilities in which managing knowledge could impact patients’ lives. This paper presents a comprehensive and phased framework for knowledge management (KM) developed and applied within the Research and Medical Analysis Laboratory of the Gendarmerie Royale in Morocco. The model is built according to the PDCA wheel, and the four pillars of methodology are: leadership, knowledge core process, performance evaluation, and finally elements for its continuous improvement. This KM framework will help identify the knowledge needs and expectations of the medical laboratory’s relevant interested parties, support medical laboratory professionals with the decision-making process, and therefore enhance the quality of the services they provide.

Indications for laboratory tests in primary care: assessment of the most frequent indications and requests with blank clinical information

Introduction

The aim of this work is twofold. Firstly, to study the temporal evolution in the number of laboratory requests from primary care without clinical indication, and to analyse the number of such requests before and after the implementation of an automated requesting procedure. Secondly, to investigate what are the most frequent clinical indications that prompted laboratory testing.

Materials and methods

This is a retrospective observational study conducted from January 2009 to December 2015. We counted the requests without clinical question, calculated the number of such requests per total number of requests and listed the most frequent indications.

Results

The number of tests requests with a blank clinical indication was significantly higher in 2009 when compared to 2015 (80% vs. 20%; P < 0.001). For every year in this 7-year period, dyslipidemia, essential hypertension and diabetes were the most prevalent diagnoses that prompted a laboratory test in primary care, accounting for more than 20% of all indications.

Conclusions

The number of primary care requests without patient clinical question has decreased after the implementation of an automated requesting procedure. Disorders of lipid metabolism, essential hypertension and diabetes mellitus were the most prevalent diagnoses that prompted a laboratory test in primary care.

Alert value reporting: a new strategy for patient safety

OBJECTIVES

The objectives of this study are to introduce the "alert value reporting" concept in primary care setting, to propose a list of chemistry and hematology alert limit tests that can be chosen for that strategy, to show how this notification procedure can be designed and established, and finally to evaluate the effectiveness and physicians' satisfaction regarding the proposed approach. In contrast to critical value reporting, alert value reporting would not allude to a result that may imply a life-threatening situation, but would indicate that an early diagnostic/therapeutic action would improve the patient's management and quality of life.

DESIGN AND METHODS

A list of chemistry and hematology alert limit tests to be used for the strategy was agreed upon between laboratory professionals and general practitioners. Next, a retrospective 12-month study involving more than 1 million laboratory tests was made to check how many of these alert values would have been communicated if these theoretical alert values had been applied. A prospective analysis of every reported alert value during 6 months was carried out to assess the intervention effectiveness and the requesting physician's satisfaction with the new strategy.

RESULTS

The alert value reporting was successfully executed. 20% of the reported alert values motivated the decision to reschedule the next patient's appointment. 90% of physicians considered alert value reporting as an interesting strategy to be continued.

CONCLUSIONS

Alert value reporting strategy motivated changes in patient's management. Further studies are needed to test if this approach can contribute to enhance patient safety and decision-making.

Regional variations in test requiring patterns of general practitioners in Spain

OBJECTIVE

To analyze the requesting patterns for a range of laboratory tests ordered in 2009 from eight laboratories providing services to eight health areas, using appropriate indicators.

DESIGN

Indicators measured every test request per 1,000 inhabitants, and indicators that measured the number of tests per related test requested by general practitioners were calculated. The savings generated, if each Health Care Department achieved the appropriate indicator standard, were also calculated. Laboratory Information System registers were collected, and indicators were calculated automatically in each laboratory using a data warehouse application.

RESULTS

There was a large difference in demand for tests by health areas. The ratio of related tests also showed a great variability. The savings generated if each Health Care Department had achieved the appropriate indicator standard were €172,116 for free thyroxine, €18,289 for aspartate aminotransferase, and €62,678 for urea.

CONCLUSIONS

Considerable variability exists in general practitioners' demand for laboratory tests.